| NPI | 1962483305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60732229) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 634942) |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2018-11-08 |